L.A. Care Covered Drug Formulary (pdf)

Commercial FormularyT2 aripiprazole ABILIFY(SOLUTION) QL, STT2 aripiprazole ABILIFY(TAB) QL, STAntipsychotics, Dopamine & SerotoninAntagonistsT1 loxapine succinateLOXITANEAntipsychotics,atypical,dopamine,&Serotonin AntagT3 asenapine maleate SAPHRIS QL, STT4 clozapine CLOZARIL QLT4 clozapine FAZACLO QL, STT3 iloperidoneFANAPT(TAB DS PK) QL, STT3 iloperidone FANAPT(TAB) QL, STT3 lurasidone hcl LATUDA QL, STT1 olanzapine ZYPREXA QLT3 paliperidone INVEGA(TAB ER QL, ST24H)(1.5 MG)T3 paliperidone INVEGA(TAB ER QL, ST24H)(3 MG)T3 paliperidone INVEGA(TAB ER QL, ST24H)(6 MG)T3 paliperidone INVEGA(TAB ER QL, ST24H)(9 MG)T1 quetiapine fumarate SEROQUEL QLT2 quetiapine fumarate SEROQUEL XR QLT1 risperidone RISPERDAL(SOLUTI QLON)T1 risperidone RISPERDAL(TAB) QLT1 ziprasidone hcl GEODON QLAntipsychotics,dopamine Antagonists,ThioxanthenesT1 thiothixeneT1 thiothixeneT2 thiothixeneT1 thiothixeneT1 thiothixeneAntipsychotics,dopamineAntagonists,butyrophenonesT1 haloperidolT1 haloperidol lactateAntipsychotics,dopamineNAVANE(CAP)(10MG)NAVANE(CAP)(2 MG)NAVANE(CAP)(20MG)NAVANE(CAP)(5 MG)THIOTHIXENEHALOPERIDOLHALOPERIDOLLACTATEAntagonst,dihydroindolonesT3 molindone hclMOBANAnti-psychotics,phenothiazinesT1 chlorpromazine hclT1 fluphenazine hclT1 perphenazineCHLORPROMAZINEHCLFLUPHENAZINE HCLPERPHENAZINE(TAB)(16 MG)T1 perphenazineT1 perphenazineT1 perphenazineT2 perphenazineT1 thioridazine hclT1 trifluoperazine hclBarbituratesT3 butabarbital sodiumT1 phenobarbitalT3 secobarbital sodiumPERPHENAZINE(TAB)(16MG)PERPHENAZINE(TAB)(2 MG)PERPHENAZINE(TAB)(4 MG)PERPHENAZINE(TAB)(8 MG)THIORIDAZINE HCLTRIFLUOPERAZINEHCLBUTISOL SODIUMPHENOBARBITALSECONAL SODIUMHypnotics, Melatonin Mt1/mt2 ReceptorAgonistsT3 ramelteon ROZEREM QL, STMonoamine Oxidase(mao) InhibitorsT3 selegiline EMSAM QLNarcolepsy And Sleep Disorder TherapyAgentsT3 armodafinil NUVIGIL PAT1 modafinil PROVIGIL PANarcotic AntagonistsT1 naltrexone hclREVIASedative-hypnotics,non-barbiturateT1 chloral hydrate SOMNOTET3 doxepin hcl SILENOR QL, STT1 estazolamESTAZOLAMT3 eszopiclone LUNESTA QL, STT3 ethchlorvynol PLACIDYLT1 flurazepam hcl FLURAZEPAM HCLT1 glutethimide GLUTETHIMIDET1 midazolam hcl MIDAZOLAM HCLT3 quazepamDORALT1 temazepam RESTORILT1 temazepam TEMAZEPAMT1 triazolamHALCIONT1 triazolamTRIAZOLAMT1 zaleplon SONATA QLT1 zolpidem tartrate AMBIEN QLT3 zolpidem tartrate EDLUAR QL, STT3 zolpidem tartrate INTERMEZZO QL, STT1 zolpidem tartrate ZOLPIDEMQLTARTRATET3 zolpidem tartrate ZOLPIMIST QL, STSsri &antipsych,atyp,dopamine&serotoninAntag CombT1 olanzapine/fluoxetine SYMBYAXhclQLPage 9 of 91